A Couple's Therapist on the Reality of What Men Think About Sex

From Samantha Rodman PhD, Dr. Psych Mom, writing at Huffington Post, this is an informative and entertaining article on what a couple's therapist has learned about male ideas about sex through talking to people in relationships.

In discussing the impact of porn on relationships, she mentions the film Don Jon, a movie recommended to me by a friend. At first it was just annoying its faux masculinity and objectification of women. But that is the point - the main character (Joseph Gordon-Levitt, who wrote and directed the film) prefers porn to women, even when he hooks up with a "ten" (Scarlett Johansson). It's not a great film, but I think it presents a reality that many men are unwilling to speak about openly, so I recommend it.

What Men Think About Sex vs. Reality

By Samantha Rodman PhD, Dr. Psych Mom
Posted: 08/09/2014

As a couples therapist, I see quite a great deal of miscommunication about sex between partners. And this is in the rare scenario where there is any communication at all. Generally, each partner thinks that the way they think about sex is obvious to the other, and nothing could be further from the truth. Here I come, like a psychology-wielding superhero, to vanquish common misunderstandings about sex for once and for all. Really. Also, I create world peace. But seriously, this post may at least function as something to email to your husband to show him how normal you are, and/or to start an honest and open discussion about your sex life.

Here are the most common incorrect assumptions that men make about sex, with my rebuttals after each.

1. Frequent and strong sexual desire and thoughts should be natural and normal for all people in long-term relationships.

Frequent and strong sexual desire and sexual thoughts are natural for normal for SOME PEOPLE in long-term relationships. These people are usually either men, or they are women who feel close, relaxed and attractive, or who are in a new and exciting relationship. Note the lack of qualifiers after the subset "men." Note all the qualifiers after the subset "women." I am not saying women don't want to have sex. However, all the recent research shows that sex drive in women tanks in monogamous relationships (see What Do Women Want?), unlike what was previously thought, which was that men grow tired of women after a while but women never get sexually bored by their partners. So basically, it is entirely normal and natural for your wife NOT to want to have sex with you, unfortunately.

The facts of the matter are that if your wife is experiencing decreased sexual desire, it is entirely normal. She is likely hitting the trifecta of libido-killers for women: long-term monogamy, exhaustion and body image issues (the latter two particularly apply after having kids).

Furthermore, any resentful feelings she has about you or the relationship in general, or anything that makes her feel insecure, will also kill her sex drive. If any or many of these issues apply, she will have to apply some real effort to get into a sexual mood, and this is completely normal. See Mating in Captivity for a more in-depth discussion of why your wife is normal in not wanting to have sex more. (Sorry, buddy.)

2. Most married couples are having sex at least three times a week, if not more.

Check out this chart. Almost half of married couples with husbands aged 25-49 fall into the "a few times a month to once a week" category. And only 5.8% of married men in their 30's are having sex four or more times per week. And who knows about these guys, anyway, because this chart doesn't distinguish between how long couples have been married for, whether they have kids, whether their wives are pregnant or nursing or whether one or both suffers from depression, anxiety or any other condition that would dampen sexual desire. From my clinical experience and Moms Night Out confidences, married fathers of small children are having sex a bit less than once a week on average. Pretty much, they aim for one to two times a week and then life and small kids get in the way of that aspiration. (Co-sleep much?)

3. Women go into sex expecting and wanting the focus to be on their pleasure.

Au contraire, women generally do not want the primary focus of the sexual encounter to be on their pleasure. Instead, I hear female clients share frequent fantasies of being with men who are overpowered by lust and desire. If a woman feels like her partner has the sole goal of giving her an orgasm, it is quite a lot of pressure and can make her feel self-conscious and awkward. This does not mean that women do not want to enjoy sex; but, they have to feel that their partner is enjoying it at least primarily because he finds her so attractive sexually that he feels urgent desire for her. Women do not respond well to a man who is trying to use various "techniques" in order to be a better lover. This makes us feel like a sudoku puzzle you are trying to solve.

4. Men who focus on a woman's pleasure (read: enjoy giving oral sex) are few and far between, but I myself happen to be one of these rare ones (note how every male client I have met thinks this).

Dispelling this myth can be my great contribution to humanity. If I had a nickel for every time I heard a man say that "unlike most guys," he "really likes" to go down on women, I would have enough nickels to build a life size statue of a man going down on a woman. And then I would auction it off on eBay, because I have children, for God's sake. Anyway, men, listen up, I would wager from clinical experience that about 80% of you say that you really like to do this. You are not the minority.

Meanwhile, back on Earth, very, very few women in long-term monogamous relationships want frequent oral sex. Really. Even the hot girls you dated in college that were all about it. Do you know why they were all about it? A few reasons: a) they were young and hormonal. Women and men are fairly similar in terms of their sexual peak; it's a myth that men peak at 18 and women at 40. Doesn't this make evolutionary sense? (This myth got propagated probably because women are too shy when young to speak up about what they want in bed, but older women are more confident so may seem more sexual.) Then, b) you were new and exciting. As I said before, women's libido decreases greatly with monogamy. Even a few years of college dating is nothing like the monogamy that comes with living with you and your underwear on the floor.

Many women find oral sex to be overwhelming (too much physical sensation in one place), it may make them feel distant from you (physically and emotionally) and not to mention, you try it at the wrong time. Many women are likelier to want oral sex when they are already aroused; trying it too early in the encounter may physically hurt and make women feel self-conscious. When their inhibitions are lowered is a better time to try, but even then, many women do not enjoy it.

5. I must last as long as I can and be in full control of myself at all times.

In my clinical experience, women do not want a man to last forever. This is consistent with what I said before, that women like when men urgently desire them. If you last forever, how urgent is your desire? Not very. Of course, if premature ejaculation (within a minute or less) is an issue, this can be helped with sex therapy or techniques you can practice yourself.

6. Also, I should engage in a lot of foreplay, all the time, because women want this.

Some do, and others prefer to just start having sex pretty soon into the encounter. For many women, having sex is what gets them into the mood to have more sex. Additionally, if your wife thinks you'll be disrupted in the middle of sex (e.g. by young kids waking up, etc), often a long elaborate sexual episode can make her anxious. Moral of the story: Don't assume your wife wants a long, drawn out sexual experience every time. Ask her, or see how she responds to something more, say, to the point.

7. Women orgasm from intercourse alone pretty frequently.

About 75% of women don't orgasm from intercourse alone. If you didn't know this already, this statistic will change your worldview. So your wife is not weird or not in touch with her sexual side. She's just your run-of-the-mill non-intercourse-orgasming woman. Phew.

8. The women I dated in high school/college/my 20's who I had lots of crazy sex with are still doing that with the men they married.

I call BS on that one, friend. I just told you about the whole monogamy and age and babies leads to decreased libido in the majority of females. If you had married that hot young thing, she would be a less hot, less young thing who wants to sit around and watch TV at night too. You know it's true if you think about it rationally.

9. My wife makes up excuses not to have sex, and other women just go with the flow and are happy to feel desired.

See above.

10. After the baby, most women get their sex drive back reasonably quickly.

If by reasonably quickly, you mean, after the last baby is 5 years old and sleeps through the night. And also if by that point they've gotten back to working out, eating right, sleeping well and feeling good about who they are as a person and not just as a mommy. In that case, yes, pretty quickly.

11. Watching porn does nothing to hurt our sex life or relationship.

I beg to differ. Yes, it's normal to masturbate and so on and so forth, BUT people have only a limited amount of energy -- mental, physical and sexual. If you're giving the best of yourself to an Internet person, it's not going to your wife. I am further willing to bet that it makes your wife feel pretty crappy to know that you're looking at other naked women, many of whom are going to look more conventionally "hot" than she looks (or feels that she looks). And the more porn men watch, the less likely they are to be satisfied with the physical appearance and sexual appetites and behaviors of their real life partner. See #7 above -- did you ever see a porn movie where the woman didn't get off from intercourse? Of course not, yet this is how the majority of women function. Anyway, watching porn is the male equivalent of when your wife sees a movie like The Notebook and then she hates you for a couple of days.

On top of this, porn can be addictive. So try and limit it. For more on this topic, see the movie "Don Jon."

Now, I am in no way saying that women cannot work on being more open to sex and get more in touch with their sexuality within their marriage (and alone, for themselves). However, the purpose of this post was to discuss the vast differences between what many (not all!) men assume about sex, and the reality of what the majority of women think and feel about it. Discussing this post with your spouse is a great way to see whether you two are on the same or different pages about sex. If you'd like some more reading on this topic, try the excellent book Wanting Sex Again: How to Rediscover Your Desire and Heal a Sexless Marriage by Laurie Watson.

And don't worry, next I'll tackle all the ways many women are wrong about sex.

• For more, visit me at Dr. Psych Mom, on Facebook, or on Twitter @DrPsychMom.
• Follow Samantha Rodman PhD on Twitter: www.twitter.com/DrPsychMom

Esther Perel is the author of Mating in Captivity: Unlocking Erotic Intelligence, a book that "invites us to explore the paradoxical union of domesticity and sexual desire, and explains what it takes to bring lust home." Sounds good to me.

Esther Perel: The Secret to Desire in a Long-Term Relationship

In long-term relationships, we often expect our beloved to be both best friend and erotic partner. But as Esther Perel argues, good and committed sex draws on two conflicting needs: our need for security and our need for surprise. So how do you sustain desire? With wit and eloquence, Perel lets us in on the mystery of erotic intelligence.

Why you should listen to her:

Psychotherapist Esther Perel is changing the conversation on what it means to be in love and have a fulfilling sex life. For the first time in human history, couples aren't having sex just to have kids; there's room for sustained desire, for couples to cultivate long-term sexual relationships. But how? Perel, a licensed marriage and family therapist, travels the world to help people answer this question.

For her research Perel works across cultures and is herself fluent in nine languages. She coaches and consults organizations and families, holds a private psychotherapy practice in New York, and speaks regularly on erotic intelligence, trauma, conflict resolution, and infidelity. She is the author of Mating in Captivity: Unlocking Erotic Intelligence.

Alexandra Sifferlin - WHY Stressed-Out Men Prefer Heavier Women

The other day I posted a research summary showing that stressed-out men prefer larger women. I speculated about skinny women being less likely survive is things are tough, with stress being an indicator that things are tough.

So now Alexandra Sifferlin at Time Magazine tells us just exactly WHY men who under stress prefer heavier women (I was pretty close to what one might suspect the evolutionary psychology people would propose).

 Jane Russell (1950s)

A little more context for this study. Until the 1960s or so, skinny women were not considered attractive. Women with curves and a little "meat on their bones" were the ideal of beauty, like Jane Russell in the image above, or Rita Hayworth (below).

Rita Hayworth (1940s)

Going back to before the 20th century, being skinny signified poverty, whereas being heavier was a sign of wealth and prosperity. Likewise, being pale showed that one did not need to go outside to work, whereas having a tan meant one was so poor that s/he had to work in the sun.

When we look back at the history of Western art, especially at the portraits that so many artists did to earn a living, the patrons who paid for those portraits were all plump by our standards. The models who posed nude for painters were generally much thinner than the patrons (compare the women in the Renoir painting below to the obviously affluent woman in the Rembrandt). Again, having some heft was associated with wealth (and power).

Rembrandt - Young Woman with a Fan (1632)

Renoir - The Bathers (1887)

The point is that our fascination with skinny women is recent - and very short-lived within the history of human desire. It's not likely that this is yet a "real" preference - give it another few decades and we'll see if it persists.

We (men) have preferred shapely women for a few millennia, now. Given that is likely still a psychological default mode, under stress we will tend to fall back into our default modes of behavior and beliefs (a kind of regression). Preferring larger women when stressed might simply be indicative that this is what we prefer in general, and it's only a socially constructed preference that we experience for skinny women.

Why Stressed-Out Men Prefer Heavier Women

By Alexandra Sifferlin

Most men prefer leggy and lean women, Gisele Bündchen lookalikes, right? Not necessarily. In fact, the body type that a man finds attractive can change depending on his environment and circumstances, a new study finds: when under stress, for instance, men prefer heavier women.

The study, published in the journal PLoS ONE, reports that when men were placed in stressful situations, then asked to rate the attractiveness of women of varying body sizes, they tended to prefer beefier frames, compared with unstressed men whose tastes skewed thinner.

“This suggests that our body size preferences are not innate, but are flexible,” said study co-author Martin Tovée of Newcastle University in the U.K., in an email, noting that they may be influenced by our particular environment and resources.

The findings fall in line with evolutionary theories that suggest when resources are scarce or unpredictable, a woman’s thin physique may signal illness, frailty and the inability to reproduce. Indeed, Tovée and colleague Viren Swami of the University of Westminster in London have previously found that men under trying conditions — like extreme hunger — tend to rate heavier women as more attractive. The researchers suggest also that underlying biological mechanisms, such as blood sugar and hormone levels, are major players in how we perceive our surroundings.

“Our work in parts of Malaysia and Africa has shown that in poorer environments where resources are scarce, people prefer a heavy body in a potential partner,” said Tovée. “If you live in an environment where food is scarce, being heavier means you have fat stored up as a buffer against a potential food reduction in the future, and that you must be higher social status to afford the food in the first place. Both of these are attractive qualities in a partner in those circumstances.”

Moving from a low-resource environment to a richer one, like the U.K. or the U.S., can cause a shift in these preferences, says Tovée, and to test the theory further, the researchers recruited some male volunteers and manipulated their stress levels — a key problem for people living in poor environments.

The study examined 81 heterosexual men, about half of whom underwent the Trier Social Stress Test. In the test, the men participated in an impromptu job interview in front of four interviewers. They were asked them to “sell” themselves for five minutes, and then calculate answers to simple math problems under time pressure.

Afterward, all the study participants were shown images of 10 women with body types ranging from emaciated to obese and were asked to rank them based on their attractiveness.

The images were numbered on a scale of 1 to 10 based on the women’s body mass index (BMI), with 1 representing very thin and 10 obese. The largest body size rated attractive by the stressed-out men was 7.17, which fell in the overweight category. The largest body type deemed attractive by the unstressed control group was 6.25, which was considered normal on the BMI scale.

Overall, stressed men preferred a bigger body — their “ideal” figure was a 4.44 — than the unstressed men, who idealized a thinner body type, at 3.90. Stressed-out men not only rated heavier women as more attractive, but they also gave higher ratings to a wider range of body types overall.


“This shift suggests that stress alters what you find attractive in a potential partner, and it is another factor helping you to optimize the fit of your partner preferences to your environment,” said Tovée.

Understanding how body preferences may change or be influenced by circumstance also sheds light on the development of warped body image, the authors say. “People suffering from conditions such as anorexia nervosa have a distorted perception of body size and body ideals, and it’s important that research focus on the mechanisms underlying and influencing the perception of body size,” says Tovée.

Despite our media’s seeming reverence for size-zero models and ripped muscle men, it may help people suffering from eating disorders and other body-image problems to know that such body “ideals” are not exactly ideal after all. “The information from this article could be useful in therapy of anxiety and eating disorders,” Dr. Igor Galynker, associate chairman of the department of psychiatry and behavioral sciences at Beth Israel Medical Center, told ABC News. “The information could be an alternative to thoughts such as, ‘I am fat; no man would find me attractive.’”

Pat Jordan - The ­Realities of Aging Can Be Humbling

There are a few things I have noticed about aging (I am 45 now) that are humbling - recovery from workouts (of all types) is slower than it was even 10 years ago; hair grows less in the places it should and more in strange places (like ears) that it shouldn't; and many of the books I read are written by people younger than I am (and I have yet to write even one book).

I am not as old as the author of the article, but I find that I am willing to trade the few humbling things for the greater emotional depth, the perspective of some real life experience, and what I hope is some wisdom gained from that experience. If I had known my 40s would be this much better than my 20s, I would have willingly fast-forwarded through the awkwardness of my 30s.

This is an old article, but it's still relevant - and Men's Journal thought so, too, because they re-posted it.

You Get Old

By Pat Jordan  Sept 2009

For any man who has led a vibrant, robust life, the ­realities of aging can be humbling. But as the author has discovered, coming to terms with that is one of life's great empowerments.

 

John Loomis 

You get old, life gets small. Not meager, pinched, just small. You don't buy groceries for a week anymore – two hours in the Publix, drenched with purpose, a grocery list that unrolls like the Dead Sea scrolls.

You get old, you shop every day, your list written on the inside cover of a matchbook. Two pork chops, a can of La Sueur peas, four corns (two for tomorrow), two rolls of toilet paper.

You never buy mangoes, avocados, grapefruits, or key limes. You just go into your backyard and pick them off your tree. When you were young, your Uncle Ben retired to Sarasota and immediately sent you oranges from his tree. You thought, How sad. Now that you're old, you send mangoes, avocados, grapefruits, and key limes to your friends. You enclose a note, very serious, explaining that key limes are not ripe when they're green. "You must wait until they turn yellow!" you write. You get old, you become an expert on fruit.

You get old, people don't notice you. You sit at a bar, sipping your Jim Beam Black, neat now, no water, no ice, when a pretty woman in her 40s sits next to you. You smile at her, say hi. She looks at you and through you around the bar.

You get old, young guys don't get pissed off anymore that you're lifting heavier weight than they are on the preacher-curl bench. Now they say, "You sure that weight isn't too heavy for you, sir?" They used to call you Mack. When you were younger you would have said, "Mind your own goddamned business!" Now you say, "Thanks, guy, I think I can handle it."

You get old, you lose your anger. It takes too much energy to be angry when you're old. You have more important things to do with your waning energy, so you hoard it like a dwindling resource. 

You get old, it's not always about you. You no longer wait for an opening in a conversation to talk about yourself, your dreams, your accomplishments. It becomes second nature to draw other people into talking about their lives. You're no longer the life of the party, making people laugh. You no longer have that neurotic compulsion to be known. Why should you? You get old, you know yourself. 

You get old, you need less. Less food, less booze, less sex, less sleep. One Jim Beam Black after dinner, savored, so that it lasts until you fall asleep.

You get old, you wake at 4 a.m. as if to catch every moment of your fading days. You struggle out of bed, let the dogs out, make coffee, light a cigar, then go out the front door for your newspapers. You sit on the front steps, sipping your coffee, smoking your cigar in the darkness until Jean Pierre, the Haitian paper deliverer, as black as a purple plum, pulls up in his Toyota. He sees you and gets out of the car. "Sorry, cher, da be late today," he says, handing you the papers. "No problem, Jean Pierre." 

You get old, you eat dinner at 4 p.m., with your wife. You talk about the day, then save half of each of your pork chops, wrapped in Saran wrap, for tomorrow's dinner. Your refrigerator is stocked with leftovers. Susie wants to throw them out in a day or two, but you stop her, turn the wilting asparagus, the sautéed mushrooms, a few grape tomatoes into a lovely frittata for dinner. You get old, you hate to waste things.

You get old, you see your wife in her tight T-shirt with the words IT'S NOT EASY BEING PRETTY scripted across her breasts, and you get an idea. But it's only three o'clock in the afternoon, so you file it away for future reference. When you were young, you'd put that idea into action anytime, anyplace. Now you talk about it with her, make plans for sex. She puts on her silk negligee before she gets in bed. Then you both begin watching Ballykissangel, getting so caught up in it (will Father Peter leave the priesthood and marry Assumpta?) that the next thing you know you're waking up at 4 a.m.

You get old, your dogs get old too. It never dawned on you, when you got them, all six, one year after another, that they'd all get old, one year after another, and then die. Now they're between 10 and 16 years old. Their lives are bounded by food and sleep and all the pills they take, which are lined up on the kitchen counter with yours. Glucosamine and chondroitin for their arthritic joints. Carprofen for their dislocated knees. You see them limping and press their knees back into place. They glance back at you with gratitude. You give them phenobarbital to forestall their epileptic seizures. Ciproflaxacin for their rheumy coughs and sneezes. They wake in the morning with you and begin to wheeze, sneeze, cough, like old men, like you. They have their good days and bad days, like you. You just try to keep them alive for a few more months, then a few months after that. And when they begin to die before your eyes, you feed them water and baby food through a big plastic syringe at first, and then fluids subcutaneously with a needle before that final visit to the vet.

You get old, you set goals for yourself that seem meaningless to others. Not to you. They are proof that you're not that old. Your wife asks you to "call the man" to break up the old sidewalk in the backyard so she can plant liriope. You tell her you'll do it yourself. She says, "Don't be foolish." You get the sledgehammer and begin whacking at the sidewalk in the summer heat like Cool Hand Luke. Then you wheelbarrow the broken pieces of concrete out to the front swale for the garbageman. Two days later, you can't get out of bed.

You get old, your strength and stamina go. You mow the lawn, then lie down. Your wife comes home with 10 40-pound bags of mulch. You carry them into the backyard, then lie down. You get old, you can't do everything in one day – wash the car, mow the lawn, shop for groceries, go to the gym, get a haircut. So you plan out your day like Eisenhower planning D-day. Two things, maybe three, one day, then two more the next.

You get old, you become abstemious. You never buy clothes for yourself anymore. You wear your faded Hawaiian shirts until they're so threadbare they're like filmy curtains. You trim little threads with a scissors. One day your wife throws one out. You moan, "But that was my favorite shirt!" She says, "Hoarding is a sign of old age." You sulk like a child the rest of the day.

You get old, you get your hair cut at Supercuts, $12 for seniors, and then let it grow for two months until it's curling over your ears and you look like a French diplomat. You were young, you went to a fancy salon, where the pretty blonde massaged your shoulders while cutting your hair, for $65 and a $20 tip. You get old, your wife says, "You're not going out like that!" You say, "What?" You are wearing a ripped and paint-splattered University of Miami Hurricanes T-shirt, baggy shorts, and flip-flops. You haven't trimmed your beard in days. You look like Jeremiah Johnson, if he lived in South Florida.

You used to wear $200 Tommy Bahama island shirts and $2,000 ostrich-skin cowboy boots when you went out. Your wife wore spandex minidresses and six-inch pumps. You looked like a successful drug smuggler with a high-priced hooker. You get old, you sell your cowboy boots to a thrift shop for $50 and buy the dogs new collars. You get old, your looks go. You don't care.

You were handsome once, like a Greek god, with curly black locks and luxuriant chest hair. You still are, in your mind's eye, even if your hair is so white you look like a ghost in photographs. You look at that photograph of an old man, and say out loud, "Jeez, I look like an old man!" Your friends call back, "You are an old man." A young friend of your wife's, maybe 35, picks up a photograph of you when you were 38 off the fireplace mantel. "Wow," she says. "You were hot once." You resist the urge to tell her, "I still am."

You get old, small things give you pleasure that were once an annoyance. Throwing out the garbage, you meet a neighbor walking his dog. You pet his dog, pass the time. The mailman stops at your mailbox. He talks to you about his Brazilian girlfriend, then hands you the mail. Bills, a check, and – eureka! – four movies from Netflix.

You get old, you realize order is freedom. You do your job more professionally, no longer on the fly. You get a magazine assignment – go down 1,500 feet into a coal mine in Virginia, climb a mountain in Haiti – and you prepare for it. You do heavier squats the days before you leave. You fly out the night before your interview so that you will have time to settle yourself, prepare. You get old, you check into a no-tell motel close to the thruway ramp so you have easy access to anyplace you have to go. When you were young you stayed at the best hotels, with pissing Cupid fountains in the lobby and businesswomen on the make in the bar. The first thing you did after you checked in was change your clothes and hit the bar with your barroom smile. Now you go to Denny's for a snack. Then you go back to the hotel and put your clothes in the dresser drawers and lay out all your notes on the desk so you can review them the next morning before your interview.

You get old, you realize your job these past 40 years was God's gift. When you were young, you thought you were God's gift.

You get old, you forget things, not because your mind is going, but because your memory box is filled. A name comes up and you find yourself mentally flipping through all those thousands of slides, trying to place the name with a face or an event. You forget trivial things – where you put the car keys, your glasses – because your mind is filled with more important things. Is the gate in the backyard secured so the dogs won't get out into the street and get hit by a car? You never forget that.

You get old, you scream at your wife. Not in anger, but because your hearing's going. "What?" you scream. She looks exasperated. She says loudly, "I said…." You now see the world in a faint haze, like it's covered with a gauzy film. "Pollen," you say. Your wife says, "You need stronger glasses." You refuse to admit that. So you call the Comcast TV repairman once a week. He arrives, a young black kid. "The picture's blurry," you say. "And the sound, I have to jack it way up to hear." He fiddles with the remote, then says, "The picture's fine. The sound, too. Maybe you need glasses." You stop calling the Comcast repairman.

You get old, you sell your 1989 Taurus SHO with the five-speed, short-throw shifter, the Recaro racing seats, lowered suspension, rear spoiler, 19-inch mag wheels. You buy a Lincoln LS8, with leather, a wood-trimmed dash, automatic.

You get old, you read the obits. You call out to your wife, "Jeez, Isaac Hayes died! He was an old man, I guess." Your wife calls back, "About the same age as you."

You get old, your friends are old too. Old ladies, mostly. Why not? You're an old man. Betsy, 59, Ina, 65, Julia, 76, Helen, 78. You drive Helen to work when her ride is late. You drive Betsy to the airport at 7 a.m. for a flight to visit her sister. Later, your friend John, 58, knocks on your door. He's going to visit friends in Wisconsin. Will you feed his cats while he's gone? Sure, why not? 

You get old, your dreams constrict. You no longer expect fame and fortune, your face on the cover of Time. You no longer expect to write the Great American Novel, 859 pages. Your writing gets small. Fewer words. But cleaner, you hope. More nuance, less obvious. Subtle, you like to think. Like your life. Small essays about getting old. They please you just as much as if you wrote War and Peace.

You get old, you cry more. Not over your lost dreams, your sins, your old age, your impending death. You cry for others. You cry when Assumpta dies too young, at 30, in Ballykissangel. You cry at the sight of our soldiers in camouflage walking through airports on their way to Iraq. You cry at the sight of abused dogs and cats staring at you from the pages of newspapers. You cry when Betsy tells you she has inoperable cancer and she'll never see 60.

You cry for everyone but yourself because you have lived a wonderful life, and you wish that every person, every pet, could live such a life too. When you were young, you cried only for yourself.

Hypoactive sexual desire disorder in men: Biopsychosocial approaches

What follows is a short research paper I wrote for my sexuality and psychotherapy class - I thought I'd post it here because so many men have internalized the belief that men are always ready, willing and able to have sex - and want sex more than anything else.

The reality is that men and women are not that far apart in their levels of desire, especially if we strip away the cultural beliefs and training around this topic.
____

Hypoactive sexual desire disorder in men: Biopsychosocial approaches

The cultural myth is that men think about sex every seven seconds (Ahuja, 2006). Furthermore, men are always ready, willing, and able to have sex (Brizendine, 2006, p. 91; Meuleman & Van Lankveld, 2004, p. 293; Pleck, Sonenstein & Ku, 1993, p. 21). The reality is that many men think about sex once a day or less:

According to the Kinsey Report (Sexual Behavior in the Human Male), 54 percent of men think about sex every day or several times a day, 43 percent a few times a week or a few times a month, and 4 percent less than once a month. (Dixit, 2007)

On the other hand, it is assumed and widely verified that sexual desire occurs less frequently in women and that arousal is much more complicated. One could argue the etiology of this fact, whether it is that women possess lower endogenous testosterone or that female children are socialized to be and feel less sexual, but that is another topic. What is true, however, is that women suffer from desire disorders more than men, most commonly hypoactive sexual desire disorder (HSDD) (Goldstein et al., 2006; Laumann, et al, 1994, p. 370 & 371). To be precise, the prevalence among men versus women is about 15% versus 35%, respectively (Levine, 2010, p. 40).

The Diagnostic and Statistics Manual of Mental Disorders, 4th edition, text-revision (DSM-IV-TR, American Psychiatric Association, 2000) defines hypoactive sexual desire disorder as, in summary, “Persistently or recurrently deficient (or absent) sexual fantasies and desires for sexual activity” that causes personal and relational stress, and that cannot be accounted for by Axis I disorders, substance use (including medications), or other medical conditions (p. 541). The disorder is further defined through lifelong versus acquired, generalized versus situational, and psychological versus combined factors (p. 541). There are many chemical factors that can lead to HSDD in men, most commonly anti-depressant medications (specifically, selective serotonin reuptake inhibitors and anti-hypertensive medications) as well as hormonal issues (hypogonadism or endocrine dysfunction as a result of environmental xenoestrogens) and psychological issues (anxiety, depression, and other Axis disorders) (Levine, 2010, p. 40). All of this makes a differential diagnosis more challenging.

Once ruling out medications, mood disorders, and hormonal issues, it becomes important to identify whether the situation is lifelong or acquired and situational or generalized. Further, men will often report erectile dysfunction rather than low sexual desire, further complicating diagnostic efforts (Levine, 2010, p. 41). This tendency to underreport desire disorders can likely be traced back to the cultural myths about male sexuality—a mechanical problem is bad enough, but male socialization conveys that not wanting sex is simply not masculine (Fracher & Kimmel, 1992). When clients find it difficult to discuss sexuality or sexual desire issues, The Sexual Desire Inventory (Spector, Carey & Steinberg, 1996) can be a useful tool for acquiring information in a way that allows more openness for the client (Meuleman & Van Lankveld, 2004, p. 291).

For those clients who profess they always have experienced low desire (lifelong variety), and who also believes that the low desire is ego syntonic, continued treatment may not be desirable unless the client is dissatisfied with the situation. For example, 27.4% of men aged 18 to 59 who were living with a partner had sex three times or less in the last year (10% had zero sex) and two-thirds of the men who had no sex were not troubled by it (Laumann, et al, 1994). For these men, lack of sex drive may be a character trait or an aspect of temperament with which they were born.

However, as Levine suggests, the situation is seldom as simple as innate low desire and no feelings about that loss of intimacy:

Lifelong HSDD usually reflects the constitutional endowment of sexual drive, although the internalization of antisexual values and experiences of abuse or neglect may produce a lifelong low sexual interest level. (2010, p. 41)

Levine goes on to suggest that attachment issues, which can inhibit adolescent sexual development can sometimes be at the root of low desire. In women, low desire or frequency of sexual behavior is associated with avoidant attachment, but in males it is associated with ambivalent attachment patterns (Feeney, 1999, p. 371). However, this is only one opinion—a study by Hazan, Zeifman, and Middleton (1994) found that avoidant men and women report low enjoyment of sexuality whereas ambivalent subjects of both sexes enjoy cuddling but not overt sexuality (cited in Feeney, p. 371)—there are very few studies that look at attachment issues and male hypoactive sexual desire.

Most often, HSDD manifests later in a relationship after a time of relatively normal sexual function and behavior (acquired variety). The reasons for this loss of desire can be physical, especially low androgen levels, as noted by many researchers (Knussmann, Christiansen & Couwenbergs, 1986; Mantzoros, Georgiadis & Trichopoulos, 1995; Nilsson, Moller & Solstad, 1995). There also can be other physical issues to rule out, including “various combinations of direct illness effects: treatment effects from medication, radiation, or surgery; psychological reactions to being ill; spousal reactions to the ill partner” (Levine, p. 41).

After ruling out all other issues (these are commonly seen as acquired generalized causes), the next step is to examine acquired situational issues. According to Levine, these tend to occur shortly after marriage. One variation, the Don Juan “casualty,” typically values the seduction more than conquest, and once he has “won” the women whom he often sees as a wonderful person, the sexual impulse is gone. In another variation, the pornography “casualty,” the man has been shaped and has shaped his sexual scripts through pornography. For him, an actual woman is too complex and intimidating for him to feel sexual toward. Finally, the “practical marriage casualty” results when a man chooses a wife for status and social benefits without really feeling any romantic interest. Each of these assumes a somewhat normal sexual fantasy life but a sexless relationship.

The therapist should also examine more complex, relationship-based issues. Among the variety of reasons a man may feel no sexual chemistry or desire for his wife include the following: he is having an affair, he no longer finds her sexually attractive, he finds her complaints about his sexual functioning overwhelming, her new status as a mother has rendered her asexual in his eyes, and perhaps the most irrevocable issue, he is a closeted homosexual and can no longer pretend to feel attraction for his wife even though he cannot face his sexuality. The job of the therapist is gently to explore these possibilities with the client while always keeping in mind that, “For men, sexual behavior is the ultimate expression of their manhood; beyond manhood—their personhood” (Gaylin, 1992, p. 117).

Levine argues that there are no physiological treatments (magic pills) for low sex drive (p. 42) and that there does not seem to be anything resembling a Viagra for low desire. However, he also states that none of the most common psychotherapies—cognitive-behavioral, psychodynamic, sex therapy, Psychodrama—have proven useful in treating HSDD (p. 42). Therapy can involve the man by himself, the man with his partner, or placement into a group with other men who experience similarly limited interest in their partners. While the group work may not do much to repair or save the relationship, it can help the man better understand his avoidance or motivations.

In lifelong/generalized HSDD, successful therapy may simply entail helping the couple develop strategies to maintain intimacy and a sexual common ground. With situational/acquired HSDD, successful therapy may include exploring relationship issues, physical attraction issues, family of origin issues, and a variety of other factors. Finally, it is also possible that the man developed a part—a subpersonality—whose role it is to suppress sexual desire, generally as a result of some shame-related experience (Schwartz, 1995). If that part’s “burden” can be identified and removed through therapeutic intervention (often a form of active imagination), then therapy can focus on trust-building and the creation of intimacy within the couple, but without sexual contact, until physical desire returns. However, it is handled, sensitivity to the importance men generally place on their sexuality as a major construct of their personal identity is crucial.


References
Ahuja, A. (2006, February 1). Every 7 seconds? That’s a fantasy. The Times (UK). Retrieved from http://www.timesonline.co.uk/tol/life_and_style/article723673.ece

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Text Revision ed.). Washington, DC: APA.

Brizendine, L. (2006). The female brain. New York: Broadway Books.

Dixit, J. (2007, June 4). Five shocking stats about men and sex. Psychology Today. Retrieved from http://www.psychologytoday.com/articles/200706/five-shocking-stats-about-men-and-sex

Feeney, J. A. (1999). Adult romantic attachment and couple relationships. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 355-377). New York: Guilford Press.

Fracher, J., & Kimmel, M. S. (1992). Hard issues and soft spots: Counseling men about sexuality. In M. S. Kimmel & M. A. Messner (Eds.), Men’s lives (2nd edition), (pp. 438-450). New York: Macmillan Publishing Company.

Gaylin, W. (1992). The male ego. New York: Penguin Books.

Goldstein, I., Meston, C., Davis, S., & Traish, A. (Eds.). (2006). Female sexual dysfunction. New York: Parthenon.

Knussmann, R., Christiansen, K., & Couwenbergs, C. (1986). Relations between sex hormone levels and sexual behaviour in men. Archive of Sexual Behavior, 15, 429-445.

Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

Levine, S. (2010, June). Hypoactive sexual desire disorder in men: Basic types, causes, and treatment. Psychiatric Times, 40-43.

Mantzoros, C. S., Georgiadis, E. L., & Trichopoulos, D. (1995). Contribution of dihydrotestosterone to male sexual behaviour. British Medical Journal, 310, 1289-1291.

Meuleman, E. J., & Van Lankveld, J. J. (2004, July 12). Hypoactive sexual desire disorder: An underestimated condition in men. BJU International, 95, 2 9 1 – 2 9 6. DOI: 10.1111/j.1464-410X.2005.05285.x

Nilsson, P., Moller, L., & Solstad, K. (1995). Adverse effects of psychosocial stress on gonadal function and insulin levels in middle-aged males. Journal of Internal Medicine, 237, 479-486.

Pleck, J. H., Sonenstein, F. L., & Ku, L. C. (1993). Masculinity ideology: Its impact on adolescent males’ heterosexual relationships. Journal of Social Issues, 49(3), 11-29. Retrieved from SocINDEX with Full Text database.

Schwartz, R. C. (1995). Internal family systems therapy. New York: Guilford Press.

Spector, I. P., Carey, M. P., & Steinberg, L. (1996). The Sexual Desire Inventory: Development, factor structure, and evidence of reliability. Journal of Sexual and Marital Therapy, 22, 175–90.

Tags: Hypoactive sexual desire disorder, men, Biopsychosocial, DSM-IV-TR, masculinity, sexuality, Sexual Dysfunction, health, desire, HSDD, Diagnostic and Statistics Manual of Mental Disorders, desire disorders, stereotypes, cultural constructs, SSRI